Spondyloarthritis is a spectrum of disease affecting the spine. In its most aggressive form, spondyloarthritis can cause fusion of the entire spine. At the other end of the spectrum is the start of inflammation of the sacroiliac joints before changes are noted on xray. At this early form of disease, inflammation is only noted on magnetic resonance imaging of the spine. This form of disease is called nonradiographic axial spondyloarthritis. While biologic therapy is effective in the treatment of ankylosing spondylitis or spondyloarthritis, the benefits of biologic therapy with nonradiographic axial spondyloarthritis is less well documented.
Dougados and colleagues reported on a large scale clinical study evaluating the effects of long-term Enbrel (etarnercept) treatment on the control of nonradiographic spondyloarthritis. Patients with MR evidence of spinal inflammation without any xray changes who had failed 2 nonsteroidal anti-inflammatory drugs (NSAIDs) were eligible for the study. In the first 3 months patients received Enbrel compared to a placebo. After the initial 3 month period, all individuals were treated with Enbrel. At 104 weeks, 60% of patients had inactive disease while 75% had at least 20% improvement in disease. MR improvement was also noted at the end of the study in a majority of patients. About 8% of patients had some significant adverse events like infections.
The study demonstrates the efficacy of a biologic therapy in early spondyloarthritis prior to the development of x-ray changes. Biologics should be considered for these patients if they have failed 2 NSAIDs
Dougados M, van der Heijde D, Sieper J et al. Effects of long-termetarnercept treatment on clinical outcomes and objective signs of inflammation in early nonradiographic axial spondyloarthritis:104-week results from a randomized, placebo-controlled study. Arthritis C and Res 2017;69:1590-1598
David Borenstein, MD
Executive Editor The Spine Community.com